Deformities

Bunions (Hallux Valgus)Bunions are misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery by a podiatric physician is frequently recommended to correct the problem.

ClubfootClubfoot is one of the most common non-life threatening major birth defects. It affects your child's foot and ankle, twisting the heel and toes inward. It may look like the top of the foot is on the bottom. The clubfoot, calf and leg are smaller and shorter than normal. Clubfoot is not painful, is correctable and your baby is probably otherwise normal.

Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet clubbed. The exact cause is unknown.

Two out of three clubfoot babies are boys. Clubfoot is twice as likely if you, your spouse or your other children also have it. Less severe infant foot problems are common and are often incorrectly called clubfoot.

The goal of treating clubfoot is to make your newborn's clubfoot (or feet) functional, painless and stable by the time he or she is ready to walk. Doctors start by gently stretching your child's clubfoot toward the correct position. They put on a cast to hold it in place. One week later, they take off the cast and stretch your baby's foot a little more, always working it toward the correct position. They apply a new cast, and one week later you come back and do it again.

This process (called serial casting) slowly moves the bones in the clubfoot into proper alignment. Doctors use X-rays to check the progress. Casting generally repeats for 6-12 weeks, and may take up to four months. About half the time, your child's clubfoot straightens with casting. If it does, he or she will be fitted with special shoes or braces to keep the foot straight once corrected. These holding devices are usually needed until your child has been walking for up to a year or more.

Muscles often try to return to the clubfoot position. This is common when your child is 2-3 years old, but may continue up to age 7. Sometimes stretching, casting and bracing is not enough to correct your baby's clubfoot. He or she may need surgery to adjust the tendons, ligaments and joints in the foot/ankle.

Flat Feet (over pronation)Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible or painful flat feet may be associated with other conditions and require medical attention.

Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.

Painful progressive flatfoot, otherwise known as Tibialis Posterior Tendinitis, is caused by inflammation. The tendon becomes inflamed, stretched or suffers a partial or total tear. If left untreated, this condition may lead to severe disability and chronic pain. Some people are prone to this condition if they have flatfeet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing, or orthotic devices are the common ways of treating painful progressive flatfoot. Consult with your physician before taking any medications. Surgical intervention involves repairing the torn or damaged tendon to restore normal function. To prevent re-injury, orthotic devices or show inserts may be recommended. In severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

HammertoesHammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, resembling a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes of hammertoe include improperly fitting shoes and muscle imbalance.

Treatment for the condition typically involves shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions or non-medicated corn pads may also relieve symptoms.

Mallet ToesMallet toes are often caused by bone and muscle imbalances that become exaggerated in people with active lifestyles.

Arthritis can also lead to mallet toes. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

Treatment is designed to relieve pressure, reduce friction, and transfer forces from the sensitive areas. Shoes with a high and broad toe box (toe area) are recommended for people suffering from mallet toes. This prevents further irritation on the toe area from developing.

SpursBone spurs are a very common foot problem. Spurs in the feet most often occur in the heel and near the toes.

Growths of bone on the underside, forepart of the heel bone, heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.

Painful bone spurs also can develop on the top of the big toe joint.

Anti-inflammatory medications, cortisone injections and/or special shoes or inserts are some of the common treatments for stiff big toe. Consult your physician before taking any medication.

Surgery may be prescribed if spurring around the joint becomes severe.

Tarsal CoalitionA tarsal coalition is a bone condition that causes decreased motion or absence of motion in one or more of the joints in the foot. The lack of motion or absence of motion is due to abnormal bone, cartilage or fibrous tissue growth across a joint. When excess bone has grown across a joint, there is usually little or no motion in that joint. Cartilage or fibrous tissue growth can restrict motion of the affected joint to varying degrees, causing pain in the affected joint or in surrounding joints.

The bones found at the top of the arch, the heel, and the ankle are referred to as the tarsal bones. A tarsal coalition is an abnormal connection between two of the tarsal bones in the back of the foot or the arch. This abnormal connection between two bones is most commonly an inherited trait and passed down from generation to generation.

Symptoms usually include an aching sensation deep in the foot near the ankle or arch, accompanied by muscle spasms on the outside of the affected leg. Non-surgical treatment includes special shoes or inserts, physical therapy and anti-inflammatory medication. Consult your physician before taking any medication.

Surgery sometimes is performed to allow for more normal motion between the bones, or to fuse the affected joint or surrounding joints.